Ebola: The Next Great Pandemic?

EBOLA: THE NEXT GREAT PANDEMIC?

(This article is meant to combine and update information in some previous articles on this website.)

Several countries in West Africa are in the throes of an epidemic of Ebola virus. Over 1700 cases and 932 deaths in the countries of Guinea, Sierra Leone, Nigeria, and Liberia make it a candidate for the next great Pandemic. The disease has decimated health care workers, with a number of doctors, nurses, missionaries, and others dying from the illness. Indeed, the Peace Corps has pulled 340 workers from the area in question.

The Ebola outbreak first hit close to home when American Patrick Sawyer died in Lagos, Nigeria en route to visit his family in Minnesota. Yesterday, the nurse who treated him has succumbed to the disease and a half-dozen other suspected cases have turned up in the country.

Various cases are turning up throughout the world. A Saudi Arabian man, recently returned from Sierra Leone, fell sick and died from Ebola-like symptoms, although test are still pending at the time of this writing. A woman, also from Sierra Leone, fell ill and died in London’s Gatwick Airport, but apparently tested negative for the disease, and a New Yorker recently returned from Liberia took sick, but also tested negative.

Although Patrick Sawyer did not become Patient Zero in the U.S., other infected Americans, a doctor and nurse, were transferred to the CDC hospital in Atlanta, Georgia.

Despite all this, few people really know what Ebola virus is and how it does its damage, and they certainly don’t know what to do if it arrives in their neighborhood.

WHAT IS EBOLA?

Ebola virus is a member of the FILOVIRIDAE virus family. It was first reported in 1976 in the Democratic Republic of Congo, where it resulted in 431 deaths out of 602 known cases. Ebola is named after the river where the first victims were identified. It has several variants, and the possibility exists that the virus may have the capacity to mutate. The variety of Ebola causing all the issues in West Africa is the “Zaire” strain.

WHAT DO WE KNOW?

Not much. How Ebola manages to first infect humans is poorly understood. Primates like monkeys and apes are possible agents of transmission (also called vectors), although bats may be more likely to transmit the disease. The virus can even be transmitted to dogs, although they don’t seem to get sick. All of these animals are potential additions to human diets in the areas affected.

Ebola appears to be transmitted through saliva and other bodily fluids, even sweat. The practice of relatives and workers washing a body before burial may have helped spread the disease. The virus can live on surfaces for a number of days, unless those surfaces have been cleaned with soap and water or Chlorine bleach ( 1 1/2 cups per gallon solution).

A 2012 Canadian study suggested that the virus may also be transmitted in air droplets. Given the highly contagious nature of the disease, this would be big trouble if true, but hasn’t been proven. I would say that it is unlikely to be transmitted by simply breathing the air in the same room as an Ebola patient, but find it hard to believe that a cough or sneeze couldn’t send infectious saliva or blood right at me.

Hemorrhages under the skin in Ebola patient

WHAT EBOLA DOES

What does Ebola virus do to its victims? Ebola causes a hemorrhagic fever with a 25-90% death rate, much higher than even the worst of the influenza pandemics of the past century. Compare this to a 2.5% death rate from the great Spanish flu pandemic of 1918, and 0.1% from routine influenza outbreak.

Symptoms begin presenting about 2-21 days after exposure. Ebola patients develop the sudden onset of what first appears to be influenza: Aches and pains, cough, sore throat, shortness of breath, fever and chills, and malaise are commonly seen at this stage. Nausea is noted, often accompanied by abdominal pain, diarrhea, and vomiting.
Later on, The central nervous system becomes affected: Severe headaches, altered mental status, and seizures ensue, sometimes resulting in the patient going into a coma.
Evidence of disorders in blood clotting are seen in advanced stages of the disease. Signs include:

Once bleeding disorders occur, the likelihood of survival is slim. Although deaths from severe hemorrhage have occurred in women giving birth, multiple organ failure and dehydration leading to shock are the usual causes of death.

PREVENTION
It’s thought that Ebola doesn’t spread until a victim develops symptoms. As the illness progresses, however, bodily fluids from diarrhea, vomiting, and bleeding become very contagious. Poor hygiene and lack of proper medical supplies in underdeveloped countries, such as in West Africa impede the progress of medical authorities to tame the outbreak. The best they can do is isolate sick individuals as best they can and follow infectious disease precautions.

This is something they are, apparently, not doing so well, because so many medical personnel are getting sick. I have read one report that says over 60 native doctors have died. When the doctors and nurses are dying, you know you have an illness about which to be truly concerned. Imagine if the disease becomes worldwide. The Spanish Flu epidemic of 1918 killed 50 million people with a death rate of 2.5%. Ebola has a death rate of 60%.

TREATMENT

So how do we cure Ebola. We really aren’t sure. There is no accepted treatment, cure, or vaccine for Ebola at present. The doctors can only try to make the patient comfortable and hope they get better on their own. An experimental drug known as Zmapp have been given to the two Americans airlifted from West Africa, but time will tell if it leads to a cure. For more on Zmapp, see my corresponding report at:

So what’s the big deal? Why should an epidemic in Africa matter to citizens of countries thousands of miles away? Cases out of the epidemic zone are few and far between.

Well, this outbreak is not in the deepest areas of Africa, it’s on the west coast, a more populated and easily traveled area. As a matter of fact, 10,000 people from the area travel to Houston, Atlanta, or New York every three months. With air travel around the globe in 24 hours, this virus COULD travel fast.

Also, news about the virus is disrupting the economies of the countries affected, and their governments haven’t been all that straightforward about giving reports, until just recently. As such, many people in the countries affected are suspicious of health workers, sometimes blocking them from entering their villages with knives and machetes. At least 12 Ebola hotspots have been unable to be entered due to hostile natives.

The country of Guinea, where the first cases occurred, is the world’s largest exporter of bauxite, the ore used to make aluminum. Therefore, exports from the country go to many of the world’s manufacturing plants. With an incubation period of a couple of weeks, you might have Ebola and not even know it (until you’ve infected a lot of other people).

WHAT YOU SHOULD DO

Ebola virus is a highly contagious infectious disease. The first thing that you should do now, before the disaster has hit your area is to make a plan. This plan should involve:

1. Choosing an isolation room

2. Learning to identify symptoms of someone with Ebola (as described above)

3. Not cutting corners when it comes to washing and disinfecting (it probably has caused a lot of health workers their lives in West Africa)

5. Having a means of communication if the grid goes down (hand-cranked radios, etc.)

6. Considering safe ways to dispose of infected materials.

Picking an isolation room in your home is an important consideration, especially if you aren’t confident that medical help will be forthcoming. The room should be at one end of your domicile, have good light and a window for ventilation. You might, however, want to cover the air ducts in the room.

I recommend stocking up on masks, coveralls, eye protection, shoe covers, and gloves. Special masks called “N95” and “N100” are especially useful but a full body suit would be much more protective. I’ll be outlining a full pandemic kit in an article in the next few days.

A series of medications to serve as decongestants, fever reducers, and anti-diarrheal agents will be useful. It is especially important to have dedicated bedding and utensils for patient use only. Chlorine bleach is thought to kill Ebola, so have a good supply to disinfect countertops, doorknobs, and other surfaces.

If the epidemic has hit your area, you should be avoiding exposure to large groups of people. This is where some planning to store food and medical supplies will be very helpful. If you have food and other supplies stored in the house, it saves you multiple exposures and, perhaps, your life.

All this being said, our Modern Medical Systems are better stocked and have strict infectious controls in place. Most likely, the virus would be contained quicker and patients would receive higher levels of symptomatic treatment leading to much lower death rates than seen now in West Africa. Being prepared and aware will help all of us deal with this virus more effectively here in the United States.Joe Alton, M.D.

JOE ALTON, M.D.

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